In November 2004,
psychiatrist Paul
McHugh (the Vatican's advisor on sexual matters) came out openly and
stated his "scientific" position on "sex changes". The article
is full of the usual
BBL ideology regarding transsexualism, most of which (as you can see
in this article) goes directly all the way back to McHugh and his
colleague Jon Meyer at Johns Hopkins in the 1970's. The article is
entitled "Surgical Sex", and it can be found at the following Catholic
Church website:

This article is the latest in
a long series of attacks on "sex changes" by McHugh, going all the way
back to his personality conflicts and confrontations with John Money at
Johns Hopkins in the 70's, with McHugh personally being responsible for
closing down the gender clinic there. For more of the historical
background on McHugh, see Andrea James' page "Paul
McHugh on Transsexualism"

In his recent article, McHugh
is ruthless in his caricaturing of transsexual women, which he does in a
manner reminiscent of school-yard bullies instead of "famous
scientists". In the article he mocks these women and ridicules
them in the grossest of ways:

"...The
post-surgical subjects struck me as caricatures of women. They wore high
heels, copious makeup, and flamboyant clothing; they spoke about how
they found themselves able to give vent to their natural inclinations
for peace, domesticity, and gentleness—but their large hands, prominent
Adam’s apples, and thick facial features were incongruous (and would
become more so as they aged)...."

Here we see him making fun of
women who, through no fault of their own, had been forced by fate to be
masculinized by testosterone, and who had then in many clinics been
forced to dress as caricatures of women (in high heels and with lots of
makeup) during extended "real life tests" (RLT) as part of the
forced-protocol for obtaining access to surgeries.

Furthermore, many of the old
clinics forced trans women into RLT without the benefit of hormones,
only prescribing hormones after an extended RLT (a practice is still
enforced at
The Clarke
Institute in Canada - now called the CAMH).

McHugh's remarks are thus
seen as incredibly offensive - he is seen as ridiculing the very clients
that those old clinics forced into the torture of RLT and social
transition without the benefit of hormones. And of course McHugh ignores
any and all effects of the many modern treatments,
including
FFS, that can correct the masculinization-effects which McHugh
ridicules. Thus he is playing on crude social stereotypes of trans women
as "men in dresses", taunting and humiliating them in absentia in the
process.

Then, a little further along,
we discover that McHugh apparently sees himself as the instigator and
principal propagator of the now infamous "two-type" theory of
transsexualism. Furthermore, since he apparently believes that he
has won the scientific war against sex changes
by convincing the Vatican to denounce transsexualism in 2000, and by
supporting Mr. Bailey's book on the inside at the National Academy of
Sciences in 2003-2004, he thinks it is now time to tell the history
of his great success!

In telling this story,
he reduces the contribution of The Clarke (namely
sexologist Ray Blanchard) to that of merely confirming his and
Meyer's ideas from the mid-1970's. This greatly reduces Blanchard's
"fame" as the "discoverer" of anything, and pushes the two-type theory
back to a time in the 70's when psychiatric theories of transsexualism
(and homosexuality too) were just prejudices in disguise:

"... Thanks to this research,
Dr. Meyer was able to make some sense of the mental disorders that were
driving this request for unusual and radical treatment. Most of the
cases fell into one of two quite different groups. One group consisted
of conflicted and guilt-ridden homosexual men who saw a sex-change as a
way to resolve their conflicts over homosexuality by allowing them to
behave sexually as females with men. The other group, mostly older men,
consisted of heterosexual (and some bisexual) males who found intense
sexual arousal in cross-dressing as females. As they had grown older,
they had become eager to add more verisimilitude to their costumes and
either sought or had suggested to them a surgical transformation that
would include breast implants, penile amputation, and pelvic
reconstruction to resemble a woman. ... Further study of similar
subjects in the psychiatric services of the Clark Institute in Toronto
identified these men by the auto-arousal they experienced in imitating
sexually seductive females."

These assertions, based on
research in the 1970's, suggest why Blanchard (and later
J. Michael
Bailey and
Anne Lawrence)
also constantly refer to intense, early-onset transsexualism as "extreme
effeminate homosexuality", rather than as a form of innate gender
feelings in conflict with body sex. These assertions come down to
us from a time when homosexuality was openly pathologized by
psychiatrists - a time when psychiatrists' knee-jerk reactions were that
trans women were simply "gay men".

However, unscientific thought
they are, these assertions have been forcefully propagated for over 30
years by this very Paul McHugh, who has been in a position to make them
stick in psychiatric circles - even in the face of rapidly mounting and
massive counter-evidence against them.

We strongly suspect that when
the Bailey book came out, McHugh launched this same kind of tirade
against transsexual women inside the National Academies. McHugh is a
member of the Institute of Medicine of the National Academy of Sciences
and a member of the current
President's
Council on Bioethics. He would have been the very "top authority"
whom the leaders of the Academies turned to to learn about
transsexualism. No one there would have realized that McHugh has been on
a personal Catholic religious rampage against "sex changes", and has had
a closed mind on this entire subject, for the past 30 years.

And now, egotist that he is, McHugh is trying to steal Blanchard's
thunder by declaring that psychoanalyst Jon Meyer and he (McHugh)
were actually the researchers who originated the two-type theory of
transsexual mental illness, which we shall from now on call the "Meyer-McHugh
theory". According to McHugh, Blanchard merely made some
confirming measurements, somewhat in the vein that Bailey "made some
confirming observations of transsexuals in Chicago", and then gave a
catchy name to one of the types. But in his mind it is really
he, McHugh, who figured this all out once and for all, way back in
the 1970's.

You will also notice in his article that McHugh
also takes credit for causing and sponsoring
William
Reiner's pioneering work on the cloacal exstrophy cases. By
doing this, he moves into a position to "speak for Reiner", and thus
more easily misspeak regarding the Reiner's main findings regarding
the nature of gender. McHugh even has the nerve to ask
regarding trans women,

” Where did they get the idea that our sexual identity
(“gender” was the term they preferred) as men or women was in the
category of things that could be changed?",

i.e., suggesting that
transitioners expect SRS to change their inner identities, when in
fact SRS is done to confirm and accommodate to one's existing inner
identity. McHugh refuses to believe gendered feelings and
gendered identities exist independent of body sex - even though
Reiner's work amply demonstrates such independent-of-body-sex inner
feeling and identities.

Of course Reiner can
openly tell the story regarding his pioneering work on the negative
impacts of many intersex infant surgeries without alienating McHugh.
He can help bring more wisdom and compassion to the treatment of
infant intersex kids, who in the past have been arbitrarily assigned
to a gender based on "practical surgical considerations" rather than
waiting till they can speak and act for themselves and give their
parents some clue as to their inner identities. McHugh loved
these results, because they helped him "stop sex changes" (and in
the cases of intersex infants, this was usually a correct thing to
do).

We wonder though, will
Reiner have to wait for McHugh to pass on before telling the overall
implications of his results more fully? After all, Reiner's
cloacal exstrophy follow-ups are to gender what the moons of Jupiter
were to astronomy: The very visible and undeniable reality of
something mysterious at the time that had been previously denied (by
the Catholic Church). In this case we see stark evidence for
gendered feelings and identities that are not based on body
sex and upbringing, feelings and identities that emerge strongly
during childhood and that cry out for social and physical
expression.

William Reiner left Johns
Hopkins around a year ago or so, and is now at University of
Oklahoma at Oklahoma City. He heads a program in pediatric urology
and is doing research there.

But even so, can Reiner
really follow-up and talk about those broader implications of his
research results? Any such discussions would challenge
McHugh's position on gender. McHugh has a powerful stranglehold in
elite scientific circles on opinion in that area, and we've seen the
power wielded by McHugh against those who dare disagree with him
(for example, John Money). Would Reiner dare to openly
contradict McHugh's misinterpretations of the cloacal exstrophy
results regarding innate gender identity independent of body sex?
Only time will tell.

Since the 1950s, surgery has been the preferred method among
urologists for dealing with intersex bodies, by "normalizing"
genitalia so that children could grow up in a definitive male or
female role. Recently, however, new evidence has led some urologists
to concede that the genitals do not make the man - or the woman.

"I
don't think it matters whether you assign a sex or you don't, or
even whether you assign the correct sex," said Dr.
William Reiner, a professor in the
urology department at the University of
Oklahoma Health Sciences Center. "A child is going to
identify [himself or herself]. A child's sexual identity can only be
known by the child."

In any event, William
Reiner is a brilliant scientist and a gentleman and in the end his
pioneering work will speak for itself. He will make his mark
in scientific history not by the domineering pushing of unsound pet
theories as did Money and McHugh, but by doing it the hard way: by
doing good science.

Meantime, by prematurely
grasping for his place in history, McHugh has now tipped his hand in
his essay. He WANTS people to know about his important role in
the Vatican decision to denounce transsexualism. He wants people to
know about his role in the
National Academies' publication and promotion of the Bailey book,
a book that the prestigious Southern Poverty Law Center (SPLC) has
called "Queer
Science". He wants to be "appreciated" for what he
considers to be his important scientific efforts to "stop sex
changes".

However, the publication of this incredibly offensive and overstated
Catholic magazine article may prove to be quite a blunder by McHugh:

His irrational and
unscientific hatred of transsexual women shows through too clearly,
in his gross ridiculing and caricaturing of trans women.

He even has the nerve to
comment about how transitioning women talked incessantly about sex
in their psychiatric interviews - when it was the
interviewer-psychiatrists themselves who would talk about nothing
else but sex!

McHugh is seen here doing
great and tragic harm by making ego-maniacal warped-science
pronouncements about transsexual people, just as Money did in his
efforts to promote infant genital surgery on intersex kids.

They are two of a kind:
Money and McHugh.

Money for decades pushed
sex reassignments of intersex infants, under a bogus theory of
gender. Money insisted wrongly that gender is socially
constructed and that intersex boys could be turned into girls if
reassigned surgically early enough. He then deliberately prevented
mounting counter-evidence to his theory from being widely revealed
to his scientific colleagues. For several decades he pushed
and promoted the practice of infant intersex surgeries, even in the
face of mounting evidence that his theory was incorrect.

McHugh has for decades
tried to stop transsexual sex reassignments, under a bogus theory
that trans women are homosexual men or sexual paraphilics. By power
of position and personality he stopped (not only the infant genital
surgeries, but also) the transsexual surgeries at John's Hopkins. He
then deliberately prevented mounting counter-evidence to his theory
from being widely revealed to his scientific colleagues. For decades
now he has pushed and promoted the idea that "sex changes are
wrong", even in the face of mounting evidence that his theory was
incorrect - evidence that transsexual transitions can work out
extremely well.

In the end, just like
Money, McHugh will go down in history as a devil of a man who
shattered the lives of tens of thousands of gender variant people.
I think we should help him along in this, by making sure his
"important role" in history is fully documented and well-remembered.

Surgical Sex

Paul McHugh

Copyright (c) 2004 First Things 147 (November 2004): 34-38.

When the practice of sex-change surgery first emerged back in the early
1970s, I would often remind its advocating psychiatrists that with other
patients, alcoholics in particular, they would quote the Serenity Prayer, “God,
give me the serenity to accept the things I cannot change, the courage to change
the things I can, and the wisdom to know the difference.” Where did they get the
idea that our sexual identity (“gender” was the term they preferred) as men or
women was in the category of things that could be changed?

Their regular response was to show me their patients. Men (and until recently
they were all men) with whom I spoke before their surgery would tell me that
their bodies and sexual identities were at variance. Those I met after surgery
would tell me that the surgery and hormone treatments that had made them “women”
had also made them happy and contented. None of these encounters were
persuasive, however. The post-surgical subjects struck me as caricatures of
women. They wore high heels, copious makeup, and flamboyant clothing; they spoke
about how they found themselves able to give vent to their natural inclinations
for peace, domesticity, and gentleness—but their large hands, prominent Adam’s
apples, and thick facial features were incongruous (and would become more so as
they aged). Women psychiatrists whom I sent to talk with them would intuitively
see through the disguise and the exaggerated postures. “Gals know gals,” one
said to me, “and that’s a guy.”

The subjects before the surgery struck me as even more strange, as they
struggled to convince anyone who might influence the decision for their surgery.
First, they spent an unusual amount of time thinking and talking about sex and
their sexual experiences; their sexual hungers and adventures seemed to
preoccupy them. Second, discussion of babies or children provoked little
interest from them; indeed, they seemed indifferent to children. But third, and
most remarkable, many of these men-who-claimed-to-be-women reported that they
found women sexually attractive and that they saw themselves as “lesbians.” When
I noted to their champions that their psychological leanings seemed more like
those of men than of women, I would get various replies, mostly to the effect
that in making such judgments I was drawing on sexual stereotypes.

Until 1975, when I became psychiatrist-in-chief at Johns Hopkins Hospital, I
could usually keep my own counsel on these matters. But once I was given
authority over all the practices in the psychiatry department I realized that if
I were passive I would be tacitly co-opted in encouraging sex-change surgery in
the very department that had originally proposed and still defended it. I
decided to challenge what I considered to be a misdirection of psychiatry and to
demand more information both before and after their operations.

Two issues presented themselves as targets for study. First, I wanted to test
the claim that men who had undergone sex-change surgery found resolution for
their many general psychological problems. Second (and this was more ambitious),
I wanted to see whether male infants with ambiguous genitalia who were being
surgically transformed into females and raised as girls did, as the theory
(again from Hopkins) claimed, settle easily into the sexual identity that was
chosen for them. These claims had generated the opinion in psychiatric circles
that one’s “sex” and one’s “gender” were distinct matters, sex being genetically
and hormonally determined from conception, while gender was culturally shaped by
the actions of family and others during childhood.

The first issue was easier and required only that I encourage the ongoing
research of a member of the faculty who was an accomplished student of human
sexual behavior. The psychiatrist and psychoanalyst Jon Meyer was already
developing a means of following up with adults who received sex-change
operations at Hopkins in order to see how much the surgery had helped them. He
found that most of the patients he tracked down some years after their surgery
were contented with what they had done and that only a few regretted it. But in
every other respect, they were little changed in their psychological condition.
They had much the same problems with relationships, work, and emotions as
before. The hope that they would emerge now from their emotional difficulties to
flourish psychologically had not been fulfilled.

We saw the results as demonstrating that just as these men enjoyed
cross-dressing as women before the operation so they enjoyed cross-living after
it. But they were no better in their psychological integration or any easier to
live with. With these facts in hand I concluded that Hopkins was fundamentally
cooperating with a mental illness. We psychiatrists, I thought, would do better
to concentrate on trying to fix their minds and not their genitalia.

Thanks to this research, Dr. Meyer was able to make some sense of the mental
disorders that were driving this request for unusual and radical treatment. Most
of the cases fell into one of two quite different groups. One group consisted of
conflicted and guilt-ridden homosexual men who saw a sex-change as a way to
resolve their conflicts over homosexuality by allowing them to behave sexually
as females with men. The other group, mostly older men, consisted of
heterosexual (and some bisexual) males who found intense sexual arousal in
cross-dressing as females. As they had grown older, they had become eager to add
more verisimilitude to their costumes and either sought or had suggested to them
a surgical transformation that would include breast implants, penile amputation,
and pelvic reconstruction to resemble a woman.

Further study of similar subjects in the psychiatric services of the Clark
Institute in Toronto identified these men by the auto-arousal they experienced
in imitating sexually seductive females. Many of them imagined that their
displays might be sexually arousing to onlookers, especially to females. This
idea, a form of “sex in the head” (D. H. Lawrence), was what provoked their
first adventure in dressing up in women’s undergarments and had eventually led
them toward the surgical option. Because most of them found women to be the
objects of their interest they identified themselves to the psychiatrists as
lesbians. The name eventually coined in Toronto to describe this form of sexual
misdirection was “autogynephilia.” Once again I concluded that to provide a
surgical alteration to the body of these unfortunate people was to collaborate
with a mental disorder rather than to treat it.

This information and the improved understanding of what we had been doing led
us to stop prescribing sex-change operations for adults at Hopkins—much, I’m
glad to say, to the relief of several of our plastic surgeons who had previously
been commandeered to carry out the procedures. And with this solution to the
first issue I could turn to the second—namely, the practice of surgically
assigning femaleness to male newborns who at birth had malformed, sexually
ambiguous genitalia and severe phallic defects. This practice, more the province
of the pediatric department than of my own, was nonetheless of concern to
psychiatrists because the opinions generated around these cases helped to form
the view that sexual identity was a matter of cultural conditioning rather than
something fundamental to the human constitution.

Several conditions, fortunately rare, can lead to the misconstruction of the
genito-urinary tract during embryonic life. When such a condition occurs in a
male, the easiest form of plastic surgery by far, with a view to correcting the
abnormality and gaining a cosmetically satisfactory appearance, is to remove all
the male parts, including the testes, and to construct from the tissues
available a labial and vaginal configuration. This action provides these
malformed babies with female-looking genital anatomy regardless of their genetic
sex. Given the claim that the sexual identity of the child would easily follow
the genital appearance if backed up by familial and cultural support, the
pediatric surgeons took to constructing female-like genitalia for both females
with an XX chromosome constitution and males with an XY so as to make them all
look like little girls, and they were to be raised as girls by their parents.

All this was done of course with consent of the parents who, distressed by
these grievous malformations in their newborns, were persuaded by the pediatric
endocrinologists and consulting psychologists to accept transformational surgery
for their sons. They were told that their child’s sexual identity (again his
“gender”) would simply conform to environmental conditioning. If the parents
consistently responded to the child as a girl now that his genital structure
resembled a girl’s, he would accept that role without much travail.

This proposal presented the parents with a critical decision. The doctors
increased the pressure behind the proposal by noting to the parents that a
decision had to be made promptly because a child’s sexual identity settles in by
about age two or three. The process of inducing the child into the female role
should start immediately, with name, birth certificate, baby paraphernalia, etc.
With the surgeons ready and the physicians confident, the parents were faced
with an offer difficult to refuse (although, interestingly, a few parents did
refuse this advice and decided to let nature take its course).

I thought these professional opinions and the choices being pressed on the
parents rested upon anecdotal evidence that was hard to verify and even harder
to replicate. Despite the confidence of their advocates, they lacked substantial
empirical support. I encouraged one of our resident psychiatrists, William G.
Reiner (already interested in the subject because prior to his psychiatric
training he had been a pediatric urologist and had witnessed the problem from
the other side), to set about doing a systematic follow-up of these
children—particularly the males transformed into females in infancy—so as to
determine just how sexually integrated they became as adults.

The results here were even more startling than in Meyer’s work. Reiner picked
out for intensive study cloacal exstrophy, because it would best test the idea
that cultural influence plays the foremost role in producing sexual identity.
Cloacal exstrophy is an embryonic misdirection that produces a gross abnormality
of pelvic anatomy such that the bladder and the genitalia are badly deformed at
birth. The male penis fails to form and the bladder and urinary tract are not
separated distinctly from the gastrointestinal tract. But crucial to Reiner’s
study is the fact that the embryonic development of these unfortunate males is
not hormonally different from that of normal males. They develop within a
male-typical prenatal hormonal milieu provided by their Y chromosome and by
their normal testicular function. This exposes these growing embryos/fetuses to
the male hormone testosterone—just like all males in their mother’s womb.

Although animal research had long since shown that male sexual behavior was
directly derived from this exposure to testosterone during embryonic life, this
fact did not deter the pediatric practice of surgically treating male infants
with this grievous anomaly by castration (amputating their testes and any
vestigial male genital structures) and vaginal construction, so that they could
be raised as girls. This practice had become almost universal by the mid-1970s.
Such cases offered Reiner the best test of the two aspects of the doctrine
underlying such treatment: (1) that humans at birth are neutral as to their
sexual identity, and (2) that for humans it is the postnatal, cultural,
nonhormonal influences, especially those of early childhood, that most influence
their ultimate sexual identity. Males with cloacal exstrophy were regularly
altered surgically to resemble females, and their parents were instructed to
raise them as girls. But would the fact that they had had the full testosterone
exposure in utero defeat the attempt to raise them as girls? Answers might
become evident with the careful follow-up that Reiner was launching.

Before describing his results, I should note that the doctors proposing this
treatment for the males with cloacal exstrophy understood and acknowledged that
they were introducing a number of new and severe physical problems for these
males. These infants, of course, had no ovaries, and their testes were
surgically amputated, which meant that they had to receive exogenous hormones
for life. They would also be denied by the same surgery any opportunity for
fertility later on. One could not ask the little patient about his willingness
to pay this price. These were considered by the physicians advising the parents
to be acceptable burdens to bear in order to avoid distress in childhood about
malformed genital structures, and it was hoped that they could follow a
conflict-free direction in their maturation as girls and women.

Reiner, however, discovered that such re-engineered males were almost never
comfortable as females once they became aware of themselves and the world. From
the start of their active play life, they behaved spontaneously like boys and
were obviously different from their sisters and other girls, enjoying
rough-and-tumble games but not dolls and “playing house.” Later on, most of
those individuals who learned that they were actually genetic males wished to
reconstitute their lives as males (some even asked for surgical reconstruction
and male hormone replacement)—and all this despite the earnest efforts by their
parents to treat them as girls.

Reiner’s results, reported in the January 22, 2004, issue of the New
England Journal of Medicine, are worth recounting. He followed up sixteen
genetic males with cloacal exstrophy seen at Hopkins, of whom fourteen underwent
neonatal assignment to femaleness socially, legally, and surgically. The other
two parents refused the advice of the pediatricians and raised their sons as
boys. Eight of the fourteen subjects assigned to be females had since declared
themselves to be male. Five were living as females, and one lived with unclear
sexual identity. The two raised as males had remained male. All sixteen of these
people had interests that were typical of males, such as hunting, ice hockey,
karate, and bobsledding. Reiner concluded from this work that the sexual
identity followed the genetic constitution. Male-type tendencies (vigorous play,
sexual arousal by females, and physical aggressiveness) followed the
testosterone-rich intrauterine fetal development of the people he studied,
regardless of efforts to socialize them as females after birth.

Having looked at the Reiner and Meyer studies, we in the Johns Hopkins
Psychiatry Department eventually concluded that human sexual identity is mostly
built into our constitution by the genes we inherit and the embryogenesis we
undergo. Male hormones sexualize the brain and the mind. Sexual dysphoria—a
sense of disquiet in one’s sexual role—naturally occurs amongst those rare males
who are raised as females in an effort to correct an infantile genital
structural problem. A seemingly similar disquiet can be socially induced in
apparently constitutionally normal males, in association with (and presumably
prompted by) serious behavioral aberrations, amongst which are conflicted
homosexual orientations and the remarkable male deviation now called
autogynephilia.

Quite clearly, then, we psychiatrists should work to discourage those adults
who seek surgical sex reassignment. When Hopkins announced that it would stop
doing these procedures in adults with sexual dysphoria, many other hospitals
followed suit, but some medical centers still carry out this surgery. Thailand
has several centers that do the surgery “no questions asked” for anyone with the
money to pay for it and the means to travel to Thailand. I am disappointed but
not surprised by this, given that some surgeons and medical centers can be
persuaded to carry out almost any kind of surgery when pressed by patients with
sexual deviations, especially if those patients find a psychiatrist to vouch for
them. The most astonishing example is the surgeon in England who is prepared to
amputate the legs of patients who claim to find sexual excitement in gazing at
and exhibiting stumps of amputated legs. At any rate, we at Hopkins hold that
official psychiatry has good evidence to argue against this kind of treatment
and should begin to close down the practice everywhere.

For children with birth defects the most rational approach at this moment is
to correct promptly any of the major urological defects they face, but to
postpone any decision about sexual identity until much later, while raising the
child according to its genetic sex. Medical caretakers and parents can strive to
make the child aware that aspects of sexual identity will emerge as he or she
grows. Settling on what to do about it should await maturation and the child’s
appreciation of his or her own identity.

Proper care, including good parenting, means helping the child through the
medical and social difficulties presented by the genital anatomy but in the
process protecting what tissues can be retained, in particular the gonads. This
effort must continue to the point where the child can see the problem of a life
role more clearly as a sexually differentiated individual emerges from within.
Then as the young person gains a sense of responsibility for the result, he or
she can be helped through any surgical constructions that are desired. Genuine
informed consent derives only from the person who is going to live with the
outcome and cannot rest upon the decisions of others who believe they “know
best.”

How are these ideas now being received? I think tolerably well. The
“transgender” activists (now often allied with gay liberation movements) still
argue that their members are entitled to whatever surgery they want, and they
still claim that their sexual dysphoria represents a true conception of their
sexual identity. They have made some protests against the diagnosis of
autogynephilia as a mechanism to generate demands for sex-change operations, but
they have offered little evidence to refute the diagnosis. Psychiatrists are
taking better sexual histories from those requesting sex-change and are
discovering more examples of this strange male exhibitionist proclivity.

Much of the enthusiasm for the quick-fix approach to birth defects expired
when the anecdotal evidence about the much-publicized case of a male twin raised
as a girl proved to be bogus. The psychologist in charge hid, by actually
misreporting, the news that the boy, despite the efforts of his parents to treat
him and raise him as a girl, had constantly challenged their treatment of him,
ultimately found out about the deception, and restored himself as a male. Sadly,
he carried an additional diagnosis of major depression and ultimately committed
suicide.

I think the issue of sex-change for males is no longer one in which much can
be said for the other side. But I have learned from the experience that the
toughest challenge is trying to gain agreement to seek empirical evidence for
opinions about sex and sexual behavior, even when the opinions seem on their
face unreasonable. One might expect that those who claim that sexual identity
has no biological or physical basis would bring forth more evidence to persuade
others. But as I’ve learned, there is a deep prejudice in favor of the idea that
nature is totally malleable.

Without any fixed position on what is given in human nature, any manipulation
of it can be defended as legitimate. A practice that appears to give people what
they want—and what some of them are prepared to clamor for—turns out to be
difficult to combat with ordinary professional experience and wisdom. Even
controlled trials or careful follow-up studies to ensure that the practice
itself is not damaging are often resisted and the results rejected.

I have witnessed a great deal of damage from sex-reassignment. The children
transformed from their male constitution into female roles suffered prolonged
distress and misery as they sensed their natural attitudes. Their parents
usually lived with guilt over their decisions—second-guessing themselves and
somewhat ashamed of the fabrication, both surgical and social, they had imposed
on their sons. As for the adults who came to us claiming to have discovered
their “true” sexual identity and to have heard about sex-change operations, we
psychiatrists have been distracted from studying the causes and natures of their
mental misdirections by preparing them for surgery and for a life in the other
sex. We have wasted scientific and technical resources and damaged our
professional credibility by collaborating with madness rather than trying to
study, cure, and ultimately prevent it.

Paul McHugh is University Distinguished Service Professor of Psychiatry at
Johns Hopkins University.

3. FIRST THINGS

The Journal of Religion, Culture and Public Life

Correspondence
(February 2005)

Copyright (c) 2005 First Things 150 (February 2005): 2-4.

Transsexual Truths?

In “Surgical Sex” (November 2004) Paul McHugh is certainly right to assert that
sexual identity (or, as I prefer, gender) is not subject to change; it is most
certainly inherent. About nearly everything else, however, Dr. McHugh is quite
wrong. To begin with, I honestly have to wonder how many transsexuals Dr. McHugh
has encountered, either before or after surgery. While some do match his
descriptions, most of those I know have actually been quite successful in their
transformation and are indistinguishable from other women.

Contrary to Dr. McHugh’s claims, many transsexual women show considerable
interest in children and many mourn the fact that they will never be able to
bear a child. I myself have cried bitter tears over this. And yes, some
transsexual women do identify as lesbian—just like women who are not
transsexual. Likewise, many transsexual men identify as gay. Such is to be
expected if transsexualism is more than just a choice.

The report published by Jon Meyer (and cited authoritatively by Dr. McHugh)
was met with considerable skepticism at the time it was published. It was widely
criticized for methodological flaws, while other studies have shown that Meyer’s
study was incorrect in its conclusions. Nevertheless, it was used by Johns
Hopkins as an excuse to shut down its gender identity clinic. I also note that
Dr. McHugh mentions the Clarke Institute. The fact is that this agency has a
notorious reputation for mistreating transsexual patients, forcing them to meet
unreasonable standards, and denying them the hormones needed to modify their
bodies.

One wonders why Dr. McHugh would choose such a cruel approach to the
treatment of transsexuals. Sex- reassignment surgery has proven to be the only
successful treatment for these patients, and yet for some reason he wishes to
deny this. He makes a rather clumsy attempt to justify his position by comparing
the treatment of adults who are transsexual with the treatment of children who
are intersexed. Ironically, the arguments for one contradict the arguments for
the other. Children who are intersexed have traditionally been surgically
altered in whatever manner is simplest. This has often resulted in a child who
has a male brain being given a female body. As Dr. McHugh points out, such a
child is tormented by the attempt to force him to live at odds with his natural
inclinations. And yet, he cannot find the compassion to provide treatment to
those who, for whatever reason, were born male but whose brains were not
sexualized as male in the womb. Even though both groups face the same set of
problems, Dr. McHugh sets out to protect one group while effectively punishing
the other.

Jennifer Usher
San Francisco, California

4. Ongoing citations of McHugh's article (as if it were "science")

by transphobic
religious ideologues

McHugh's offensive article in First Things was immediately
propagated by groups such as "Concerned Women for America". On October
22, 2004, CWFA posted the following news item on their website
(including a voice interview). Note the blatant duplicity in this
article, which refers to the 1979 closing of the Johns Hopkins gender
clinic as if it had just happened - instead of being old history long
bypassed by later scientific, medical and clinical events:

"Research Condemns Sex-Change Operations:
"Johns Hopkins University has stopped performing sex change
operations, both on adults and on infants born with ambiguous genitalia.
The move is the result of long-term research showing once again that
some things, like sexual identity, can not be changed surgically. Martha
Kleder spoke with Dr. Janice Crouse, senior fellow with the Beverly
LaHaye Institute, on this work of Paul McHugh, University Distinguished
Service Professor of Psychiatry at Johns Hopkins University, published
in the November, 2004 issue of First Things." CWFA.org, 10-22-04.

It also wasn't long before McHugh's article was exploited to support
Executive Branch policy-making: On October 15, 2005 the Internal Revenue
Service disallowed a woman's tax deduction for sex reassignment surgery
(SRS) - citing McHugh's teachings in the Catholic religious magazine as
a basis for its decision.

This IRS ruling was duplicitous in the same manner as had been CWFA,
citing the Hopkins clinic closing as if it had just recently happened.
For more information on this ruling see:

In 2008, The Pilot (the official newspaper of the Catholic Archdiocese
of Boston) continued the citation of McHugh's First
Things essay (along with pronouncements by reversionist Zucker) as
if it has been published in a scientific journal, in an article
berating efforts to improve public understanding of
gender-variant children:

January 4, 2008:
"Educating our Children" - "According to experts in the field
Dr. Kenneth Zucker and Susan Bradley, these children have many other
problems beside gender identity disorder. When gender identity disorder
is identified early and treated, it can be resolved. . . .

Dr. Paul McHugh
of Johns Hopkins University, where the so-called “sex change” operations
were promoted in the past, looked into the results of such treatments
when he took over. He found the claims unconvincing and discontinued the
practice. He wrote:

“As for the adults who came to us claiming to have discovered their
‘true’ sexual identity and to have heard about sex-change operations, we
psychiatrists have been distracted from studying the causes and natures
of their mental misdirections by preparing them for surgery and for a
life in the sex. We have wasted scientific and technical resources and
damaged our professional credibility by collaborating with madness
rather than trying to study, cure, and ultimately prevent it.”

The impact of McHugh's teaching on Catholic
thinking is then seen in examples such as the refusal by a Catholic
hospital of routine cosmetic surgery on a transitioned woman. Where will
the escalation of Catholic transphobia end? Perhaps in the refusal of
any and all medical care to transitioned women?:

See the following news report for an example of the extreme positions taken
by Catholic ideologue Paul McHugh. In this case he is quoted as opposing an
abortion for a 10 year old girl who had been raped:

- "One expert,
Paul McHugh, a
professor of psychiatry at Johns Hopkins, then discussed the files —
though not identities — in a videotaped interview arranged by
anti-abortion activists that quickly made its way to Mr. O’Reilly and
others in the news media. . . “I can only tell you,” he said in his
taped interview, “that from these records, anybody could have gotten an
abortion if they wanted one.” Yet Dr. McHugh’s description of the
files left out crucial bits of context. He failed to mention, for
example, that one patient was a 10-year-old girl, 28 weeks pregnant, who
had been raped by an adult relative. Asked about this omission by The
New York Times, Dr. McHugh said that while the girl’s case was
“terrible,” it did not change his assessment: “She did not have
something irreversible that abortion could correct.””